Single-knot versus multiple-knot technique of perineal repair: a randomised controlled trial.

PURPOSE: An important factor influencing the outcome of perineal repair is the repair technique. This study was done to determine if there is a difference in post perineal repair pain scores following the use of the standard multiple-knot technique (MKT) of perineal repair and a single-knot technique (SKT). METHODS: We randomised 260 women who sustained a second-degree perineal tear at the University of Benin Teaching Hospital, Benin City, Nigeria and had perineal repair using either a SKT or a MKT between 1 July 2014 and 28 February 2015. Primary outcome measure was pain assessed with a numerical rating scale (0 = no pain, 10 = worst imaginable pain) on day two, day 10 and at 3 months. Secondary outcome measures were pain scores during basic activities of daily living, analgesia use, dyspareunia and patient satisfaction. RESULTS: Mean pain scores were significantly lower in the SKT group on day two (2.8 versus 5.6; P < 0.001) and day 10 (1.8 versus 3.3; P < 0.001). Significantly fewer women in the SKT group reported pain on day two (90/126, 71.4 % versus 122/128, 95.3 %; Relative Risk [RR] 0.6, 95 % Confidence Interval [CI] 0.6-0.8; P < 0.001), and day 10 (69/126, 54.8 % versus 107/128, 83.6 %; RR 0.7, 95 % CI 0.5-0.7; P < 0.001)]. Women in the SKT group were more likely to be satisfied with outcome of repair at three months (RR 1.4, 95 % CI 1.2-1.5; P < 0.001). No difference in pain scores and dyspareunia at 3 months. CONCLUSIONS: SKT of perineal repair is associated with significantly less pain in the first 10 days postdelivery and a higher patient satisfaction rate at 3 months.

A randomised controlled trial of amniotomy and immediate oxytocin infusion versus amniotomy and delayed oxytocin infusion for induction of labour at term.

BACKGROUND: There is uncertainty as to the optimal time interval between amniotomy and oxytocin administration when inducing labour. The aim of this study was to compare the efficacy of amniotomy and immediate oxytocin infusion with amniotomy and delayed oxytocin infusion for induction of labour at term. METHOD: A total of 123 women were randomly chosen to receive either amniotomy and immediate oxytocin infusion (referred to as the 'immediate group') or amniotomy and delayed oxytocin infusion (referred to as the 'delayed group'). The main outcome measure was the proportion of women in established labour at 4 h as well as the proportion that delivered within 12 h of amniotomy. Data were analysed using standard statistical methods. RESULTS: Women in the immediate group were more likely to be in established labour 4 h post-amniotomy [relative risk (RR) 12.8; 95% CI 55.1-111.7], have a shorter amniotomy to delivery interval (P < 0.001) and achieve vaginal delivery within 12 h (RR 1.5; 95% CI 1.2-12.6). There was no difference between the groups with regards to the mode of delivery, incidence of uterine hyperstimulation and abnormal foetal heart rate recording. Compared to the delayed group, women in the immediate group were more likely to be satisfied with the induction process (RR 4.1, 95% CI 1.1-16.1) and the duration of labour (RR 1.8 95% CI 1.0-3.3). CONCLUSION: In induction of labour at term, amniotomy and immediate oxytocin infusion is associated with the establishment of active labour at 4 h, a shorter amniotomy-delivery interval and greater maternal satisfaction.

Emergency peripartum hysterectomy in a tertiary London hospital.

OBJECTIVE: The objective was to review all emergency peripartum hysterectomies performed at a tertiary hospital in London, UK, and to identify the risk factors for emergency peripartum hysterectomy. METHOD: A retrospective case control study. The cases consisted of all women who had emergency peripartum hysterectomy between 1 January 1993 and 31 December 2003. Controls were women who delivered immediately before and after the indexed case. Demographic data, medical and surgical histories, pregnancy, intrapartum and postpartum data were collected. Differences between cases and controls were compared with chi2, Fisher exact and Student t tests. Multiple logistic regression analysis was performed to identify independent risk factors for emergency peripartum hysterectomy. RESULTS: There were 15 cases of emergency peripartum hysterectomy in 31,079 deliveries, giving a rate of 0.48 per 1,000. Women who had emergency peripartum hysterectomy were significantly older (mean age 37 years vs. 29 years, P<0.001) and multiparous (P=0.02). More of the cases had a history of uterine surgery (67 vs. 30%, P=0.01), placenta praevia (60 vs. 3%, P<0.0001) and were delivered by caesarean section (86.7 vs. 30%, P=0.003). Eighty percent of the hysterectomies were performed in the daytime and all were done by consultants. Haemorrhage due to placenta praevia was the main indication for emergency peripartum hysterectomy (47%). Independent risk factors for emergency peripartum hysterectomy were older age (odds ratios [OR] 1.2, 95% confidence interval [95% CI] 1.2-1.6), multiparity (OR 2.6, 95% CI 1.3-10.2), history of previous caesarean section (OR 13.5, 95% CI 2.7-65.4), caesarean delivery in index pregnancy (OR 11.6, 95% CI 2.1-68.6) and caesarean delivery in index pregnancy for placenta praevia (OR 18, 95% CI 3.6-69). CONCLUSION: Caesarean deliveries, especially repeat caesareans in women with placenta praevia, significantly increase the risk of emergency peripartum hysterectomy.